ANSWER: No one knows, but probably an autoimmune process with environmental factors contributing

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QUESTION: What are the extraintestinal manifestations seen in both types of IBD?

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ANSWER:

– ankylosing spondylitis

– aphthous (oral) ulcers

– iritis

– pyoderma gangrenosum

– erythema nodosum

– clubbing of fingers

– sclerosing cholangitis

– arthritis

– kidney disease (nephrotic syndrome, amyloid deposits)

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QUESTION: In contrast to ulcerative colitis, Crohn’s disease of the colon:

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a. Is not associated with increased risk of colon cancer

b. Frequently presents as daily hematochezia

c. Is usually segmental rather than continuous

d. Has a lower incidence of perianal fistulas

e. Never develops toxic megacolon

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ANSWER: The answer is c: Crohn’s is patchy, segmental, chronic, and penetrates bowel wall to form fistulas, but seldom causes rectal bleeding. UC is mucosal ulcerating process that extends continuously from rectum proximal and has frequent rectal bleeds. Both can have toxic megacolon and both increase risk of cancer in large bowel.

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QUESTION: Match the clinical comment below to either being associated with Crohn’s disease, Ulcerative colitis, Both, or Neither.

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A. Anal involvement in 50%

B. Rectal involvement frequently seen

C. Small bowel involvement common

D. Chronic diarrhea, cramps, and fever

E. Curative surgery available

F. Toxic megacolon

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ANSWER:

A – Crohn’s disease

B – Both

C – Crohn’s disease

D – Both

E – Ulcerative colitis

F – Both

– Rectal involvement can be seen with both of these inflammatory diseases of the colon but is more common in ulcerative colitis (95% vs 50%)

– The clinical prsentations of these two entities are similar: chronic diarrhea, cramping, abdominal pain, and fever.

– a toxic megacolon can be an emergent, life threatening complication of either ulcerative colitis or Crohn’s disease, although it occurs less frequently with the latter.

ULCERATIVE COLITIS

– In ulcerative colitis, the anus is spared,

– “Backwash ileitis” a nonspecific dilatation of the terminal ileum, occurs in perhaps only 10% of patients with ulcerative colitis and has no prognostic or physiologic implications.

– Bloody stools, common with ulcerative colitis, are less common in Crohn’s disease.

– Total proctocolectomy or colectomy, rectal mucosectomy, and ileal pouch-anal anastomosis eliminate ulcerative colitis, whereas there is no curative operation for Crohn’s disease.

CROHN’S DISEASE

– In Crohn’s disease, anal or perianal disease is the first manifestation in 25-30% of cases.